After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?
Palpate lymph nodes for swelling.
Check temperature for elevation.
Inspect skin for bruising or petechiae.
Examine oral mucosa for ulceration.
The Correct Answer is C
Choice A rationale:
Palpating lymph nodes for swelling is not directly related to thrombocytopenia. Thrombocytopenia is a condition characterized by a low platelet count, which can lead to easy bruising and bleeding. Checking lymph nodes is more relevant in assessing for infection or malignancy.
Choice B rationale:
Checking temperature for elevation is important for assessing infection, which could be a cause of thrombocytopenia. However, in this context, inspecting the skin for bruising or petechiae is more specific to thrombocytopenia. Petechiae are small, red or purple dots that appear on the skin when platelet count is low.
Choice D rationale:
Examining oral mucosa for ulceration is essential in the assessment of conditions like oral cancer or infection. While thrombocytopenia could lead to bleeding in the oral mucosa, it is not the most specific or immediate concern in a patient with known thrombocytopenia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","B"]
Explanation
Choice A rationale:
Anemia is not a direct manifestation of target organ damage from hypertension.
Choice B rationale:
Aneurysm is a correct answer. Persistent high blood pressure can weaken the walls of arteries, making them more susceptible to forming an aneurysm. Aneurysms can occur in various arteries, such as the aorta, and can lead to life-threatening complications if they rupture.
Choice C rationale:
Proteinuria is also a correct answer. Hypertension can damage the kidneys, leading to proteinuria, the presence of excess proteins in the urine. This is an indication of kidney damage and is a common manifestation of hypertensive target organ disease.
Choice D rationale:
Pneumonia and Transient Ischemic Attack (TIA) are not direct manifestations of target organ damage from hypertension.
Correct Answer is C
Explanation
Choice A rationale:
Enteric-coated iron is designed to be absorbed in the small intestine, not the stomach. Taking it with each meal might decrease its absorption due to interaction with food.
Choice B rationale:
Cobalamin (vitamin B12) deficiency can cause macrocytic anemia, not microcytic hypochromic anemia. Taking cobalamin with green, leafy vegetables does not address the specific iron deficiency seen in microcytic hypochromic anemia.
Choice C rationale:
Take the iron with orange juice 1 hour before meals is the correct answer. Vitamin C enhances the absorption of non-heme iron (the type of iron found in plant-based foods and iron supplements) by reducing it to a more absorbable form. Taking iron supplements with orange juice, which is high in vitamin C, can significantly improve iron absorption. Taking it before meals ensures better absorption due to reduced interaction with other dietary components.
Choice D rationale:
Decreasing the intake of antiseizure medications will not improve microcytic hypochromic anemia. Antiseizure medications do not directly influence iron absorption or the production of red blood cells.
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